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1992, 08-17 Permit App: 92006485 Gas LogMEICAL PERMIT APPLICATION ORM ii1formatign Worksheet JOB STREET ADDRESS: /V/ 2/ CITY/STATE/ZIP: �,% 2 , i,L�•� l� OWNER: e sCi-f dreg' 01a-toLi3 PARCEL NUMBER: PHONE NUMBER: cic2h ��.3-(D MAILING ADDRESS: (Street) (City/State) CONTRACTOR: Heat Transfer Inc. LICENSE NUMBER: H e a t t i -1881 n PHONE NUMBER: 328-3400 MAILING ADDRESS: N. 1008 Ruby Spokane. WA 99202 (ZiP) (Street) (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) 0V GAS WATER HEATER GAS EQUIPMENT +100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET) BOILER/REFRIG 1-100M BTU BOILER/REFRIG 501-1,000M BTU •B'OILI=R/IEFRI `I,0001rr• 50M BTU BOILER/REFRIG +1,750M BTU ..................................................................................................................... :HEAT PUMP 8� AIR CONDITIONER 0 3 TONS>' HEAT PUMP & AIR CONDITIONER 3-15 TONS ;HEAT PUM$ AIRONDI:TIONER 15.;.30 TONS; HEAT PUMP & AIR CONDITIONER 30-50 TONS HEATPUMP AIR CONDITIONER +50 TONS VENTILATING FANS EVAPOR;>.ATIVECOOLE ........;;:.,ORA.;.:.;,:;E;COO.RS:.;::.:;�;;:.::.;::.:. TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TY::: E.:1:1.:HOOD.::;;;::::.::::.; CLOTHES DRYER UNUSTED GAS APPLIANCE <400,000 BTU USED APPUANCE <400,000 BTU AIR HANDLER <10,000 CFM • NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE (zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x10.00= /0.c)r) x10.00 = x 50.00 = x100.00 = x 50.00 =. 1 4 1992 :i & SAFETY x100.00 = x12.00 = x 15.00 = SUBTOTAL $ X0.0© PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE z = $ 350© Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675